Medical Management of Endometriosis in Patients with Chronic Pelvic Pain

Endometriosis is a common cause of pelvic pain in women of reproductive age. Traditional medical therapies are hormonal in nature, including estrogen progestin contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists. Other hormonal options are androgens and aromatase inhibitors, with research also suggesting a possible role for GnRH antagonists and selective progesterone receptor modulators. Other than nonsteroidal anti-inflammatories, further work is required for nonhormonal therapies such as antiangiogenic and immune-modulating drugs. Medical treatment of endometriosis can be complex, and requires consideration of side effects, the anatomic type of endometriosis, role of surgery, current infertility or future fertility desires, and other contributors to pain (e.g., central sensitization). These factors should be discussed for each patient, to ensure personalized treatment and optimal outcomes.